Fluid and

Electrolytes:
Balance
NCM 112A:
MEDICAL-SURGICAL NURSING
 FUNDAMENTAL CONCEPTS
(Amount and Composition of Body Fluids)
▪ Approximately, 60% of the weight of a typical adult consists of fluid.

▪ Body fluid is located in two fluid compartments: the INTRACELLULAR SPACE and the
EXTRACELLULAR SPACE.

▪ Approximately two thirds of body fluid is in the intracellular fluid (ICF) compartment and is
located primarily in the skeletal muscle mass.

▪ Approximately one third is in the extracellular fluid (ECF) compartment.

▪ Circulatory and neurologic symptoms, physical examination findings, and laboratory test results
can be used to identify the compartment from which fluid is lost.
 FUNDAMENTAL CONCEPTS
(Amount and Composition of Body Fluids)
▪ The intravascular space contains plasma, the effective circulating volume.
▪ The interstitial space contains the fluid that surrounds the cell and totals about 11 to 12 L in
an adult.
▪ The transcellular space is the smallest division of the ECF compartment and contains
approximately 1 L.
▪ Loss of ECF into a space that does not contribute to equilibrium between the ICF and ECF is
referred to as a third-space fluid shift, or “third spacing” for short.
▪ Third-space shifts occur in patients who have hypocalcemia, decreased iron intake, severe liver
diseases, alcoholism, hypothyroidism, malabsorption, immobility, burns and cancer.
▪ Electrolytes in body fluids are active chemicals.
 FUNDAMENTAL CONCEPTS
(Amount and Composition of Body Fluids)
▪ Electrolyte concentration in the body is expressed in terms of milliequivalent (mEq) per liter, a
measure of chemical activity, rather than in terms of milligrams (mg), a unit of weight.

▪ Normal movement of fluids through capillary wall into the tissues depends on HYDROSTATIC
PRESSURE at both the arterial and the venous ends of the vessel and the osmotic pressure
exerted by the protein of plasma.
 FUNDAMENTAL CONCEPTS
(Regulation of Body Fluid Compartments)
OSMOSIS AND OSMOLALITY:

▪ The diffusion of water caused by a fluid concentration gradient is known as OSMOSIS.

▪ TONICITY is the ability to of all the solutes to cause an osmotic driving force that promotes
water movement from one compartment to another.

▪ Osmotic pressure is the amount of hydrostatic pressure needed to stop the flow of water by
osmosis.

▪ Oncotic pressure is the osmotic pressure exerted by proteins.

▪ Osmotic diuresis is the increase in urine output caused by the excretion of substances.
 FUNDAMENTAL CONCEPTS
(Regulation of Body Fluid Compartments)
OSMOSIS DIFFUSION
 FUNDAMENTAL CONCEPTS
(Regulation of Body Fluid Compartments)
DIFFUSION:

▪ It is the natural tendency of a substance to move from an area of higher concentration to one
of lower concentration.

FILTRATION:

▪ Hydrostatic pressure in the capillaries tends to filter fluid out of the intravascular compartment
into the interstitial fluid.
 FUNDAMENTAL CONCEPTS
(Regulation of Body Fluid Compartments)
SODIUM-POTASSIUM PUMP:

▪ The high intracellular potassium concentration is maintained by pumping potassium into the
cell.

▪ ACTIVE TRANSPORT implies that energy must be expended for the movement to occur against
a concentration gradient.
 FUNDAMENTAL CONCEPTS
(Systemic Routes of Gains and Losses)
KIDNEYS:
▪ The usual daily urine volume in the adult is 1 to 2 L.
SKIN:
▪ Sensible perspiration refers to visible water and electrolyte loss through the skin.
▪ Continuous water loss by evaporation occurs through the skin as insensible perspiration, a
nonvisible form of water loss.
LUNGS:
▪ The lungs normally eliminate water vapor at a rate of approximately 300 ml every day.
 FUNDAMENTAL CONCEPTS
(Systemic Routes of Gains and Losses)
GASTROINTESTINAL TRACT:

▪ The usual loss through GI tract is 100 to 200 ml daily, even though approximately 8 L of fluid
circulates through the GI system every 24 hours.
 FUNDAMENTAL CONCEPTS
(Laboratory Tests for Evaluating Fluid Status)
▪ OSMOLALITY is the concentration of fluid that affects the movement of water between fluid
compartments by osmosis.

▪ Osmolality is reported as milliosmoles per kilogram of water (mOsm/kg).

▪ In healthy adults, serum osmolality is 280 to 300 mOsm/kg, and normal urine osmolality is
200 to 800 mOsm/kg.

▪ OSMOLARITY, another term that describes the concentration of solutions (mOsm/L).

▪ URINE SPECIFIC GRAVITY measures the kidneys’ ability to excrete or conserve water.

▪ BUN is made up of urea, which is an end product of the metabolism of protein by the liver.
 FUNDAMENTAL CONCEPTS
(Laboratory Tests for Evaluating Fluid Status)
▪ CREATININE is the end product of muscle metabolism.

▪ HEMATOCRIT measures the volume percentage of red blood cells in whole blood and normally
ranges from 42% to 52% for males and 35% to 47% for females.

▪ URINE SODIUM values changes with sodium intake and the status of fluid volume: as sodium
intake increases, excretion increases; as the circulating fluid volume decreases, sodium is
conserved.
 FUNDAMENTAL CONCEPTS
(Homeostatic Mechanisms)
KIDNEY FUNCTIONS:

▪ Regulation of ECF volume and osmolality by selective retention and excretion of body fluids.

▪ Regulation of normal electrolyte levels in the ECF by selective electrolyte retention and excretion.

▪ Regulation of pH of the ECF by retention of hydrogen ions.

▪ Excretion of metabolic wastes and toxic substances.

HEART AND BLOOD VESSEL FUNCTIONS:

▪ The pumping action of the heart circulates blood through the kidneys under sufficient pressure to
allow for urine formation.
 FUNDAMENTAL CONCEPTS
(Homeostatic Mechanisms)
LUNG FUNCTIONS:

▪ Through exhalation, the lungs remove approximately 300 mL of water daily in the normal adult

PITUITARY FUNCTIONS:

▪ The hypothalamus manufactures ADH, which is stored in the posterior pituitary gland and
released as needed to conserve water.

ADRENAL FUNCTIONS:

▪ Aldosterone, a mineralocorticoid secreted by the zona glomerulosa of the adrenal cortex, has a
profound effect on fluid balance.

▪ Cortisol, another adrenocortical hormone, has less mineralocorticoid action.

FLUID REGULATION CYCLE
(ADH, BP, ECF, GFR)
 FUNDAMENTAL CONCEPTS
(Homeostatic Mechanisms)
PARATHYROID FUNCTIONS:
▪ it is embedded in the thyroid gland, regulate calcium and phosphate balance by means of
parathyroid hormone (PTH).
OTHER MECHANISMS:
▪ The BARORECEPTORS respond to changes in the circulating blood volume and regulate in the
circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as
endocrine activities.
▪ RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM
Renin is an enzyme that converts angiotensin, a substance formed by the liver, into angiotensin I.
Angiotensin-converting enzyme (ACE) converts angiotensin I to angiotensin II. Aldosterone is a
volume regulator and is also released as serum potassium increases, serum sodium decreases, or
adrenocorticotropic hormone (ACTH) increases.
 FUNDAMENTAL CONCEPTS
(Homeostatic Mechanisms)
▪ ANTIDIURETIC HORMONE (ADH) AND the THIRST Mechanism have important roles in
maintaining sodium concentration and oral intake of fluids.

▪ OSMORECEPTORS are located on the surface of the hypothalamus, osmoreceptors sense

changes in sodium concentration.

▪ RELEASE OF ATRIAL NATRIURETIC PEPTIDE

Atrial natriuretic peptide (ANP), also called atrial natriuretic factor, is a peptide that is
synthesized, stored, and released by muscle cells of the atria of the heart in response to several
factors.
 ROLE OF ANP IN
MAINTENANCE OF FLUID BALANCE
 FUNDAMENTAL CONCEPTS
(Gerontologic Considerations)
Dehydration in the elderly is common as a result of decreased kidney mass, decreased
glomerular filtration rate, decreased renal blood flow, decreased ability to concentrate urine,
inability to conserve sodium, decreased excretion of potassium, a d a decreases of total body
water.